Edgefield County School District
Office of Exceptional Children
Classroom Intervention Plan
Date: ______________________________
This Classroom Intervention Plan has been developed to provide academic interventions that are above and
beyond what is being provided during whole group instruction. These interventions are being delivered because
the teacher has identified an area(s) in which the student needs differentiated instruction. The classroom
teacher will provide this instruction to the student either individually and/or in a small group within the
classroom setting. The student’s progress will be monitored, documented, and communicated to the parent.
Student Name: __________________________________________ Grade: ____________________________
Faculty Member: ________________________________________ Subject: ____________________________
Identified Area of Concern(s):_________________________________________________________________
__________________________________________________________________________________________
How do I know this is a concern? (Initial Assessment/Pre-measure): Please complete all that apply.
Method of Assessment
Result of Assessment
Classroom Observation
Test/Quiz Scores
Work Samples/Rubrics
Tally Sheets
Frequency Chart
Other: _______________
What can I do to intervene at the classroom level?
Intervention(s):_____________________________________________________________________________
__________________________________________________________________________________________
Intervention Schedule: Begins: ____________ Frequency:_________________ Ends: ____________________
How do I know if the intervention made a difference? (Follow-up Assessment/Post-measure): Please
complete all that apply.
Method of Assessment
Result of Assessment
Classroom Observation
Test/Quiz Scores
Work Samples/Rubrics
Tally Sheets
Frequency Chart
Other: _______________
Did the intervention work?
Yes
No
If not, what is my next step? _________________________________________________________________
February 2013
CIP